A History-Making Operation Using Facial Tissue from a Suicide Victim Restores Isabelle Dinoire's Damaged Lips and Nose. Now Doctors Debate the Risks and Hidden Costs

One night this past May, Lucie Dinoire, 17, and her sister Laure, 13, decided to spend the night at their grandmother's in the French town of Valenciennes, not far from the apartment they share with their divorced mother, Isabelle. At 7 the next morning, the phone rang. It was a groggy Isabelle. "She asked if we'd like to take the dog for a walk, and her voice sounded funny," Lucie told Britain's Sun newspaper. The girls hurried home. "I let myself in and immediately saw blood all over the floor of the darkened room," says Lucie. Her mother was with Tania, their pet Lab mix, and Isabelle's face "was just a big mass of congealed blood," Lucie said. "I couldn't make out what had happened, but I knew it was very bad."

Though the full circumstances of Isabelle Dinoire's accident remain unclear, what is certain is that the only facial feature left intact was, said Lucie, "Mum's eyes." But after a history-making operation performed by French doctors Nov. 27, Dinoire's appearance has been surgically restored. Using the nose, lips and chin of an anonymous brain-dead donor, a team led by surgeons Jean-Michel Dubernard and Bernard Devauchelle spent 15 hours performing the world's first partial face transplant, meticulously replacing skin, nerves and muscles (see box) that had been torn away by Dinoire's dog after Isabelle took sedatives and fell into a deep sleep. The results were startling: On awakening the next day at a hospital in the city of Amiens and seeing her new face for the first time, Dinoire scribbled the word merci on a message board. "Then she cried and cried," says Sylvie Testelin, one of her surgeons. "Everyone in the room cried."

News of the procedure immediately ignited a debate over whether the risky experimental surgery—an estimated one-third of major transplants result in the patient's death—should have been performed on Dinoire. Patients must be able to deal with a lifetime of taking antirejection drugs (whose side effects can include cancer and lethal infections) and a long road to full recovery. Yet Dinoire admitted that on the night of the dog attack, she took sleeping pills in a suicide attempt—an obvious sign of instability. Ironically, the anonymous donor, another 38-year-old woman, had committed suicide by hanging herself.

Critics also blasted the French team for operating hastily before conventional facial reconstruction had been attempted on Dinoire. Another inconvenient fact: Although Dr. Dubernard made headlines once before, in 1998, by performing a hand transplant, his patient for that procedure decided, after more than two years of painful recovery, to have the transplanted hand amputated. "I'm not against face transplants, but I think we are traveling at too fast a speed," says University of Pennsylvania bioethicist Dr. Arthur Caplan. "People may ask what could be worse than living with a distorted face. Well, you could be dead."

Dr. Dubernard insists he had his patient's full consent and says he remains dedicated to working toward a complete success. "My philosophy is very simple," he said at a Dec. 2 press conference in Lyon. "We are doctors, and we helped a patient with a very severe condition." Nobody disputes that: Dinoire's injuries, while not life-threatening, were severely debilitating. In the six months following her injury, she wore a mask in public and "had great difficulty speaking," says Carine Comby, head of the French health agency that oversees organ transplants and approved the procedure. Adds surgeon Testelin: "Isabelle spent all of her time in the hospital, mostly knitting. She always ate alone, and at the end, when she couldn't really open her mouth wide anymore, she had to feed herself through a straw."

Now transferred to a hospital in Lyon, Dinoire is eating, speaking and learning to move her new lips; at best, she can't expect to have any feeling in her new tissue for months. But doctors already see signs that she's up to the challenge. Initially despondent that her dog was put to sleep, she kept a photo of the animal by her hospital bed. Now, however, she has picked out a new puppy to take home. "The doctors have given me back my face," she told The Sun. "Now I can live again."

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HOW THEY DID IT On Nov. 26, when surgeon Bernard Devauchelle rushed to a hospital in Lille to view the potential donor for the world's first face transplant, "I was stupefied by what a good match it was physically," he says—similar coloring and even skin thickness. The donor was brain-dead. In France, unless a patient declines to be an organ donor, doctors may recover whichever organs they need, but in this case they secured the family's permission. Shortly after midnight, the operation began. Eight surgeons started the arduous process of connecting the donor's tissue, which had been kept in a cold pack, to the patient's underlying facial structure. Fifteen hours later, they finished. But that was just the first leg of the process. Four days later, trying to forestall rejection, Dinoire's doctors gave her a transplant of the donor's bone marrow to try to minimize her body's own immune response to the transplant. With luck, she will regain muscle control in her face, sensation will return within a few months, and blood supply, carried by arteries and veins, will nourish the transplanted tissue. Other hurdles include the chance of infection, which is higher when the mouth is involved, since it naturally has more bacteria than external skin. According to Dr. Bruce Cunningham, president of the American Society of Plastic Surgeons, smaller-scale tissue transfers are generally successful; once the graft has survived for 48 hours, it has a small risk of deteriorating. As for the trauma of waking up with someone else's face, says Cunningham, "our experience is that radical physical changes get incorporated into a new body image and psychological persona."

WHEN WILL IT HAPPEN HERE? Surgeons are already working on the first American face transplant—but it won't happen in a hurry. According to Dr. Maria Siemionow of the Cleveland Clinic in Ohio, one of at least two U.S. hospitals with similar projects in the works, doctors there will consider only candidates who have already exhausted reconstructive options and are clearly ready to risk the cancer, kidney damage and infection that are possible side effects of lifelong immunosuppression. Amy Acton of the Phoenix Society, a support group for burn patients, says none of the severely disfigured survivors she has talked to would opt for a transplant. "They just aren't willing to take a risk of that magnitude," she says. But spectacular—and lasting—results in France could change that.